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Old 04-16-2005, 01:01 PM
Pat&Robin Pat&Robin is offline
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Hi, not sure if I posted here before, brief history, my husband Pat needs ADR, been researching and waiting for it for about 1 1/2. We have workman's comp and BCBS Federal. Both have been contacted, both say they do not have billing code 0091T in their computer system, thereby not being able to pay it. The kicker is, our doctor's office requested surgery early January under the old code(fusion code plus another non-specific code). Workman's comp AGREED to pay for that, but by the time they approved it (early April) the nurse at the doctor's office said, "ADR has a new code assigned, we have to use that one", resubmitting the request. Neither insurance has this code in their system. Well, looking at the AMA website, I find that code 0091T was "Released Jan 1 2005, Implemented July 1 2005" My thinking is that insurances probably won't update their codes until July?? Here is what the AMA website says:

Concurrent with the development of CPT-5, the CPT Editorial Panel has approved the "early release" of the new CPT Category III codes. All changes provided as an "early release" of Category III codes is not intended to take effect until the implementation date. To assist users in reporting the most recently approved Category III codes, the AMA�s CPT web site will feature updates of the CPT Editorial Panel actions and early release of the Category III codes in July and January in a given CPT cycle. These dates for early release correspond with the quarterly CPT Editorial Panel meetings for each CPT cycle (May, August, November, and February).

Does anyone else understand this to mean that the doctor's office/hospital should be able to use the old coding until July??? This is driving me nuts, why else would there be an "release" date and an "implementation" date?? I plan to call other doctor's offices on Monday to see how they are doing this.

thanks for any help,
Robin
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Old 04-16-2005, 03:02 PM
Alastair Alastair is offline
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There is a link in the FAQ`s look there
Best
Alastair
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  #3  
Old 04-16-2005, 03:47 PM
ESL ESL is offline
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here is what i wrote to someone else about codes.....its on a pre-auth i have for my 2 disc procedure in 12 days.

I have 3 codes on my pre-authorization:

63090 63091 and 22851
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Old 04-16-2005, 05:31 PM
JL JL is offline
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Codes FYI. I called medicare and gave them the codes above and they returned my call and said they would pay for the procedure. I called my doctor and was told the codes 63090, 63091 and 22851 don't exist. The temporary code 090T and 091T are tracable to the AMA site that Harrison listed. I have been informed that the "63" designates a surgerical procedure. If a=b and b=c then a=c. (This I think is uni-dimensional). I think we are chasing our tails and being laughed at. I can not think of any better format to believe right now than a pre-autorization. Someone must have had the procedure with coding on the paperwork to share with us. I do have one more clue that my diagnosis is 722.52 and I hope it is not for removal of any other part than L5.
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  #5  
Old 04-16-2005, 07:15 PM
ESL ESL is offline
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those codes are new so if you doctor does not have the latest set of codes he will not have those.....I am getting those codes done at a top notch hospital in santa monica.....pretty durned sure those codes exist.

the fact that medicare approved means there is a procedure to approve.....I would trust medicare's recognizing those codes over you doctor's not recognizing them as gospel....
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Old 04-16-2005, 11:47 PM
Pat&Robin Pat&Robin is offline
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Alastair, thanks...but your link just takes me to the AMA page that I questioned in my original post. Just wanting help interpreting it's meaning.

ESl, not sure about the first two codes you listed but I have an authorization from WC with the 22851, which is the spinal fusion code I believe, that they use to bill before ADR was assigned it's own code. You are fortunate that your doctor will accept that. My doctor and his hospital will not accept that(even though that is the code they requested authorization for originally) because they are afraid they will not get paid. And they will not bill under the old codes because they say that is fraud, even though both my BCBS and WC said to go ahead and have them bill that way. If I could find a surgeon I trusted willing to bill fraudulently, I'd go for it!!! I guess what I am trying to point out is that if you read the AMA quote that I posted earlier, it seems to me that doctors/hospitals don't have to use the new codes until JULY. Am I right?? Nobody has addressed that question for me, anyone care to try, lol???
thanks,
RObin
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Old 04-17-2005, 10:13 AM
JL JL is offline
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July code implementation date, I'll buy that as a reason for ADR procedure back up. I can see why the hospitals can not take a risk of not being paid and they probably have case history as their teacher. My scheduled date is so close to July 1 that it leaves me wondering if there is not a connection to the magic pay date. My experience has led me to believe there was something more going on and it is nice to know I am not alone in thinking of it. I have been on the phone at least weekly since 11/04 to the doctors and it seems suddenly I am a go. Not complaining, I'll take whatever and whenever I can get. I was told early on it is the hospitals not the doctors. In fact the doctor even said he would do whatever ($$$ too) to help me. But it seemed like something magical just happened. I would also ask does anyone know for sure about Robins' July date information? I agree with you ESL that Medicare favorable response to the codes is encouraging, but I was told that the doctors and hospitals want it in writing and the second hand news from me the patient isn't enough. Medicare told me they don't pre-approve anything in writing.
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  #8  
Old 04-17-2005, 08:32 PM
Kim Kim is offline
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Robin to answer your question yes I believe that you are right that in the wording above the codes will not go into effect until July and will not be published or implemented for payment until then. This is why everyone seems to not know they exist. They do not exist for anyone to find since they are not supposed to be in effect yet. I dont know about the old code being able to be used til then. I do know that there are folks who have had ADR that had WC and have had their claims paid.
Kim
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